What is the Colon?

 

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• The Colon is also called the large intestine.

• The Ileum (last part of the small intestine) connects to the Cecum (first part of the colon) in the lower right abdomen.

• The rest of the colon is divided into four parts:

 

- The ascending colon travels up the right side of the abdomen.

- The transverse colon runs across the abdomen.

- The descending colon travels down the left abdomen.

- The sigmoid colon is a short curving of the colon, just before the rectum.

• The colon removes water, salt, and some nutrients forming stool.

• Muscles line the colon's walls, squeezing its contents along.

• Billions of bacteria coat the colon and its contents, living in a healthy balance with the body.

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What are the problems associated with the Colon?

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• Colitis - Inflammation of the colon, inflammatory bowel disease or infections are the most common causes.

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1. Signs & Symptoms​

• Abdominal pain

• Cramping

• Diarrhea (one of the hallmark symptoms of colitis) with or without blood in the stool

• Associated symptoms depend upon the cause of colitis and may include:

• Fever

• Chills

• Fatigue

• Dehydration

• Eye inflammation

• Joint swelling

• Canker sores

• Skin inflammation

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​2. Diagnosis​​

• Conduct a medical history and physical exam.

• Look inside your colon and rectum with flexible sigmoidoscopy or colonoscopy. The doctor uses a small, lighted scope to look inside the intestine. In general, colonoscopy is preferred, because it can be used to see the entire colon. Both procedures can be used to take a sample (biopsy) of intestinal tissue. Biopsies are collected during sigmoidoscopy or colonoscopy to see if you have ulcerative colitis. A biopsy also may be done to look for cancer.

• Other exams and tests that may be used include:

  • Abdominal X-ray. It provides a picture of the inside of the abdomen.

  • Barium enema. It allows the doctor to examine the colon.

  • Computed tomography (CT) scan or MRI. These provide detailed pictures of the inside of the body.

  • Stool analysis (including a test for blood in the stool). This test looks for blood, signs of bacterial infection, parasites, or white blood cells.

  • Blood and urine tests to check for anemia, inflammation, or malnutrition.

  • An erythrocyte sedimentation rate (ESR, or sed rate) or a C-reactive protein (CRP) blood test may be done to look for infection or inflammation.

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3. Treatment

• Treatment for ulcerative colitis depends mainly on how bad the disease is. It usually includes medicines and changes in diet. A few people have symptoms that are long-lasting and severe, in some cases requiring more medicines or surgery.

• You may need to treat other problems, such as anemia or infection.

• Treatment in children and teens may include taking nutritional supplements to restore normal growth and sexual development.

• If you don't have any symptoms or if your disease is not active (in remission), you may not need treatment. But your doctor may suggest that you take medicines to keep the disease in remission.

• If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.

• Mild symptoms may respond to:

  • Antidiarrheal medicines

  • Enemas or suppositories that contain medicine

  • Amino salicylates relieve inflammation in the intestines. They are also taken to keep the disease in remission.

  • Steroid medicines. Your doctor may prescribe these for a few weeks to control active disease.

  • Changes in your diet.

• Moderate to severe symptoms usually require steroid medicines to control inflammation. The dose you need may be higher than that needed to treat mild symptoms. When inflammation goes away, you will take amino salicylates to keep the condition in remission.

• Severe symptoms also may be treated with:

  • Immunomodulator medicines or cyclosporine. These strong medicines suppress the immune system to prevent inflammation.

  • Biologics. They block the inflammatory response in your body and help reduce the inflammation in your colon. They may be used if other medicines don't control your symptoms.

  • Surgery - Removal of the large intestine (colon) cures ulcerative colitis. But surgery may not cure all of the problems that the condition can cause in other areas of the body, such as the liver and joints. Surgery also is done to treat problems such as bleeding or toxic megacolon.

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4. Prevention

 

• You cannot prevent ulcerative colitis, because the cause is unknown.

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• Diverticulosis - Small weak areas in the colon's muscular wall allow the colon's lining to protrude through, forming tiny pouches called diverticuli. Diverticuli usually cause no problems, but can bleed or become inflamed or infected.

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1. Signs & Symptoms

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• Most people don’t have symptoms

• Over time, some people get an infection in the pouches (diverticulitis)

• Your doctor may use the term painful diverticular disease. It's likely that painful diverticular disease is caused by irritable bowel syndrome (IBS) that may cause:

  • Diarrhea

  • Cramping abdominal (belly) pain, with no fever or other signs of infection.

 

2. Diagnosis

 

• Barium enema X-ray

• Colonoscopy

 

3. Treatment

 

• The best way to treat diverticulosis is to avoid constipation. Here are some ideas:

  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.

  • Drink plenty of fluids, enough so that your urine is light yellow or clear like water.

  • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.

  • Take a fiber supplement, every day if needed. Read and follow all instructions on the label, or consult with a doctor before doing so.

  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when you are having a bowel movement.

 

• This treatment may help reduce the formation of new pouches (diverticula) and lower the risk for diverticulitis.

 

• Treatment for painful diverticular disease involves adding fiber to the diet and not eating foods that cause gas, pain, or other symptoms. Treatment is the same as that for irritable bowel syndrome (IBS), because many people who have this condition also have IBS.

 

4. Prevention

 

• Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent diverticulosis.

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• Diverticulitis - When diverticuli become inflamed or infected, diverticulitis results. Abdominal pain, fever, and constipation are common symptoms.

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1. Signs & Symptoms​

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• Alternating diarrhea and constipation

• Painful cramps or tenderness in the lower abdomen

• Chills or fever

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2. Diagnosis

 

• Your doctor will ask questions about your medical history (such as bowel habits, symptoms, diet, and current medications) and perform a physical exam, possibly including a digital rectal exam. One or more diagnostic tests may be ordered.

  • X-rays

  • CT scanning

  • Ultrasound testing

  • Sigmoidoscopy

  • Colonoscopy

  • Blood tests to look for signs of infection or the extent of bleeding.

  • In people with rapid, heavy rectal bleeding, the doctor may perform a procedure called angiography to locate the source of the bleeding.

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3. Treatment

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• Uncomplicated Diverticulitis

  • Antibiotics, to treat infection.

  • A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet.

  • An over-the-counter pain reliever, such as acetaminophen (Tylenol, others).

  • This treatment is successful in 70 to 100 percent of people with uncomplicated diverticulitis.

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• Complicated Diverticulitis - If you have a severe attack or have other health problems, you'll likely need to be hospitalized. Treatment generally involves:

  • Intravenous antibiotics

  • Insertion of a tube to drain an abscess, if one has formed

  • Surgery if:

    • You have a complication, such as perforation, abscess, fistula or bowel obstruction

    • You have had multiple episodes of uncomplicated diverticulitis

    • You are immune compromised

  • There are two main types of surgery:

    • Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.

    • Bowel resection with colostomy. If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.

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4. Prevention​

 

• Eat a high-fiber diet that is low in fat and red meat.

• Drink plenty of water.

• Exercise regularly.

• Some people avoid nuts, seeds, berries, and popcorn, believing that these foods might get trapped in the diverticula and cause pain. But there is no evidence that these foods cause diverticulitis or make it worse.

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• Colon bleeding - Multiple potential colon problems can cause bleeding. Rapid bleeding is visible in the stool, but very slow bleeding might not be.

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1. Symptoms

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• Bright red blood coating the stool

• Dark blood mixed with the stool

• Black or tarry stool

• Bright red blood in vomit

• "Coffee-grounds" appearance of vomit

• Fatigue, weakness, pale appearance

• Anemia -- your blood is low on iron-rich hemoglobin

 

2. Diagnosis

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• The doctor will ask you questions and give you a physical examination. Symptoms such as changes in bowel habits, stool color (black or red), consistency, and whether you have pain or tenderness may tell your doctor which area of the GI tract is affected.

• The doctor will also test your stool for blood. You'll also take a blood test to check to see if you're anemic. The results will give your doctor an idea of the extent of the bleeding and how chronic it may be.

• If you have bleeding in your digestive tract, you'll likely get an endoscopy. This common procedure lets your doctor see exactly where the symptom is happening. In many cases, the doctor can use the endoscope to treat the cause of bleeding, too. It's a thin, flexible tool that is inserted through your mouth or rectum to see the areas of concern and take a tissue sample, or biopsy, if needed.

• Several other methods may be used including:

  • Angiography

  • Radionuclide Scanning

 

3. Treatment

 

• You may get an endoscopy. For instance, if your upper digestive tract is bleeding, your doctor may be able to control it by injecting chemicals directly into the problem area, using an endoscope to guide the needle. 

• A doctor can also use heat to treat (or “cauterize”) an area that’s bleeding and surrounding tissue through the endoscope, or place a clip on a bleeding blood vessel.

• Those techniques aren’t always enough. Sometimes you need surgery.

• Once the bleeding is under control, you may need to take medicine to keep it from coming back.

 

4. Prevention

 

• Prevention measures vary depending on the cause of the Colon bleeding.

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• Inflammatory bowel disease - A name for either Crohn's disease or ulcerative colitis. Both conditions can cause colon inflammation (colitis).

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1. Symptoms

 

• Cramping

• Irregular bowel habits, passage of mucus without blood or pus

• Weight loss

• Fever, sweats

• Malaise, fatigue

• Arthralgias

• Growth retardation and delayed or failed sexual maturation in children

• Extraintestinal manifestations (10-20%): Arthritis, uveitis, or liver disease

• Grossly bloody stools, occasionally with tenesmus: Typical of UC, less common in CD

• Perianal disease (eg, fistulas, abscesses): Fifty percent of patients with CD

• Diarrhea: Possible presence of mucus/blood in stool; occurs at night; incontinence

• Constipation: May be the primary symptom in UC and limited to rectum; obstipation may occur; may proceed to bowel obstruction

• Bowel movement abnormalities: Possible presence of pain or rectal bleeding, severe urgency, tenesmus

• Abdominal cramping and pain: Commonly present in the right lower quadrant in CD; occur periumbilically or in the left lower quadrant in moderate to severe UC

• Nausea and vomiting: More often in CD than in UC

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2. Diagnosis

 

• Although several laboratory studies may aid in the management of IBD and provide supporting information, no laboratory test is specific enough to adequately and definitively establish the diagnosis, including the following:

• Complete blood count

• Nutritional evaluation: Vitamin B12 evaluation, iron studies, red blood cell folate, nutritional markers

• Erythrocyte sedimentation rate and C-reactive protein levels

• Fecal calprotectin level

• Serologic studies: Perinuclear antineutrophil cytoplasmic antibodies, anti-Saccharomyces cerevisiae antibodies

• Stool studies: Stool culture, ova and parasite studies, bacterial pathogens culture, and evaluation for Clostridium difficile infection

• The following imaging studies may be used to assess patients with IBD:

• Upright chest and abdominal radiography

• Barium double-contrast enema radiographic studies

• Abdominal ultrasonography

• Abdominal/pelvic computed tomography scanning/magnetic resonance imaging

• Computed tomography enterography

• Colonoscopy, with biopsies of tissue/lesions

• Flexible sigmoidoscopy

• Upper gastrointestinal endoscopy

• Capsule enteroscopy/double balloon enteroscopy

 

3. Treatment

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• The medical approach for patients with IBD is symptomatic care (ie, relief of symptoms) and mucosal healing following a stepwise approach to medication, with escalation of the medical regimen until a response is achieved (“step-up” or “stepwise” approach), such as the following:

• Step I – Aminosalicylates (oral, enema, suppository formulations): For treating flares and maintaining remission; more effective in UC than in CD

• Step IA – Antibiotics: Used sparingly in UC (limited efficacy, increased risk for antibiotic-associated pseudomembranous colitis); in CD, most commonly used for perianal disease, fistulas, intra-abdominal inflammatory masses

• Step II – Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only

• Step III – Immunomodulators: Effective for steroid-sparing action in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates

• Step IV – Clinical trial agents: Tend to be disease-specific (ie, an agent works for CD but not for UC, or vice versa)

• Surgical Intervention

• Ulcerative colitis is a surgically curable disease. However, Crohn disease can involve any segment of the gastrointestinal tract from the mouth to the anus; surgical resection is not curative, as recurrence is the norm. In addition, repeated need for surgery and bowel resection may result in short gut syndrome and dependence on parenteral nutrition.

 

4. Prevention

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• No known dietary or lifestyle changes prevent inflammatory bowel disease (IBD), and no known dietary substances have been consistently shown to cause activation of IBD. Tobacco use has been linked to increases in the number and severity of flares of Crohn disease, and smoking cessation can help achieve remission in patients with Crohn disease. Lactose intolerance is common in persons with Crohn disease or ulcerative colitis and can mimic symptoms of IBD.

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• Diarrhea

  • Stools that are frequent, loose, or watery are commonly called diarrhea. Most diarrhea is due to self-limited, mild infections of the colon or small intestine.

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1. Symptoms

• Diarrhea makes its presence known with the urgency, frequency, and volume of your trips to the bathroom. You know that it’s diarrhea when you pass loose, watery stool two to three times a day or more. These other symptoms can also accompany diarrhea:

  • Cramping

  • Abdominal pain

  • Bloating

  • Nausea

  • Fever

  • Vomiting

 

2. Diagnosis

• Physical exam. You'll have your temperature measured to check for a fever. Your blood pressure and pulse may also be measured to check for signs of dehydration. Your doctor may also examine your abdomen for abdominal pain.

• Review of your medications. Your doctor may ask about any medications you're taking, including over-the-counter drugs. Also, tell your doctor about any supplements you take.

• Blood test. A complete blood count test may help determine what's causing your diarrhea.

• Stool test. Your doctor may recommend a stool test to determine whether a bacterium or parasite is causing your diarrhea.

 

3. Treatment 

• If your case is mild, you may not need to take anything. Or you can take an over-the-counter medicine such as bismuth subsalicylate (Pepto-Bismol, Kaopectate) or loperamide (Imodium) which are available as liquids or tablets. Follow the instructions on the package.

• If you have itching, burning, soreness, or pain in your rectal area because you have a lot of bowel movements, try these tips to feel better:

  • Take a warm bath. Afterwards, pat the area dry (do not rub) with a clean, soft towel.

  • Use a hemorrhoid cream or try white petroleum jelly.

  • Do your best to stay hydrated. You should drink at least six 8-ounce glasses of fluid each day. Choose fruit juice without pulp, broth, or soda (without caffeine). Chicken broth (without the fat), tea with honey, and sports drinks are also good choices.

 

4. Prevention

• Though some types of diarrhea, such as those due to other medical conditions, are unavoidable, infectious diarrhea can be prevented.

• The most important way to avoid diarrhea is to avoid coming into contact with infectious agents that can cause it. This means that good hand washing and hygiene are very important.

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• Salmonellosis - The bacteria Salmonella can contaminate food and infect the intestine. Salmonella causes diarrhea and stomach cramps, which usually resolve without treatment.

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1. Symptoms

• Symptoms of salmonellosis include diarrhea, fever, and abdominal cramps. They develop 12 to 72 hours after infection, and the illness usually lasts 4 to 7 days. Most people recover without treatment. But diarrhea and dehydration may be so severe that it is necessary to go to the hospital. Older adults, infants, and those who have impaired immune systems are at highest risk.

• If you only have diarrhea, you usually recover completely, although it may be several months before your bowel habits are entirely normal. A small number of people who are infected with salmonellosis develop Reiter's syndrome, a disease that can last for months or years and can lead to chronic arthritis.

 

2. Diagnosis

• Salmonellosis is diagnosed based on a medical history and a physical exam. Your doctor will ask you questions about your symptoms, foods you have recently eaten, and your work and home environments. A stool culture and blood tests may be done to confirm the diagnosis.

 

3. Treatment

• You treat salmonellosis by managing any complications until it passes. Dehydration caused by diarrhea is the most common complication. Antibiotics are not usually needed unless the infection has spread.

 

4. Prevention

• Do not eat raw or undercooked eggs. Raw eggs may be used in some foods such as homemade hollandaise sauce, Caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.

• Cook foods until they are well done. Use a meat thermometer to be sure foods are cooked to a safe temperature. Do not use the color of the meat (such as when it is no longer "pink") to tell you that it is done.

• Avoid raw or unpasteurized milk or other dairy products.

• Wash or peel produce before eating it.

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• Shigellosis

  • The bacteria Shigella can contaminate food and invade the colon. Symptoms include fever, stomach cramps, and diarrhea, which may be bloody.

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1. Symptoms

• The symptoms of shigellosis include diarrhea (often bloody), fever, and stomach cramps starting 1 or 2 days after you are exposed to the bacteria.

• Shigellosis usually lasts 5 to 7 days.

• In some people, especially young children and older adults, the diarrhea can be so severe that a hospital stay is needed. Some people who are infected may have no symptoms at all but may still spread shigellosis to others.

 

2. Diagnosis

• Because many different diseases can cause a fever and bloody diarrhea, lab tests are the best way to diagnose shigellosis.

• Your doctor will most likely still do a physical exam and ask you questions about your symptoms, foods you have recently eaten, and your work and home environments.

• A stool culture confirms the diagnosis. 

• Blood tests may be done if your symptoms are severe or to rule out other causes.

 

3. Treatment

• Shigellosis is usually treated with antibiotics. But some types of Shigella bacteria are not killed by antibiotics. This is called resistance. Because using antibiotics can make these bacteria even more resistant, mild cases of shigellosis are often not treated with antibiotics. In this case, shigellosis is treated by managing complications until it passes. Dehydration caused by diarrhea is the most common complication. Do not use medicines to prevent diarrhea.

• To prevent dehydration, take frequent sips of a rehydration drink (such as Pedialyte). Try to drink a cup of water or rehydration drink for each large, loose stool you have. Soda and fruit juices have too much sugar and not enough of the important electrolytes that are lost during diarrhea, and they should not be used to rehydrate.

• Try to stay with your normal diet as much as possible. Eating your usual diet will help you to get enough nutrition. Doctors believe that eating a normal diet will also help you feel better faster. But try to avoid foods that are high in fat and sugar. Also avoid spicy foods, alcohol, and coffee for 2 days after all symptoms have disappeared.

 

4. Prevention

• You can help prevent the spread of shigellosis by washing your hands frequently and carefully with soap, especially if you work or spend time in day care centers or with children who are not completely toilet trained. When possible, keep young children with shigellosis who are still in diapers away from uninfected children.

• If your child is in diapers and has shigellosis, after diaper changing, wipe the changing area with a disinfectant such as diluted household bleach and put the diapers in a closed-lid garbage can. Then wash your hands with soap and warm water.

• People who have shigellosis should not prepare food or pour water for others. Shigella are present in the diarrhea of people with shigellosis and for 1 or 2 weeks after symptoms have stopped.

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